Background: Titanium is commonly used for fracture fixation and is considered inert, but hypersensitivity reactions to titanium alloy still occur and are difficult to diagnose due to a lack of a universally accepted standard in post-orthopedic surgical patients, and other common diagnoses need to be differentiated. Case Presentation: This case report describes three patients with manifestations of allergic reactions to titanium-alloy implants after Open Reduction and Internal Fixation (ORIF) with Ti-6Al-4V plates. Three patients mainly presented with persistent localized dermatitis. During follow-up, radiographs confirmed bone unions, and there were no signs of purulent drainage, abscess formation, or systemic infection. Taken together, these findings reduce the possibility of fracture-related infection (FRI) and other etiologies. Conservative treatment was ineffective, and the patch test and histopathology in two patients respectively supported hypersensitivity reactions. After the implants were surgically removed, there were significant improvements in symptoms. Conclusion: Three cases of suspected titanium-alloy hypersensitivity were diagnosed by exclusion based on clinical history, laboratory results, and additional testing. The findings showed the importance of clinical history and the identification of signs and symptoms of allergic reactions, emphasizing the need for a standardized diagnostic process.

Due to the change in the structure of the proximal femur and acetabulum in patients with developmental dysplasia of the hip, total hip arthroplasty (THA) was difficult to perform for surgeons. To elevate the acetabular coverage rate, we developed a technique in the use of a patient-specific instrumentation (PSI) graft in patients with developmental dysplasia of hip (DDH) undergoing surgery. This study aims to evaluate the peri-operative outcomes of THA with PSI graft in patients with DDH. This study recruited 6 patients suffering from Crowe I DDH with secondary Grade IV osteoarthritis. All the patients underwent THA with PSI graft performed by a well-experienced surgeon. Perioperative outcomes included surgical procedures, blood loss during operation, the volume of blood transfusion, length of hospitalization, complications, and the mean difference in hemoglobin levels before and after surgery. All the outcomes analyzed were assessed by mean and standard deviation. The average duration of the surgical procedure was found to be 221.17 min, with an SD of 19.65 min. The mean blood loss during the operation was 733.33 mL, with an SD of 355.90 mL. The mean length of hospital stay was calculated to be 6 days, with an SD of 0.89 days. Furthermore, the mean difference between the pre- and postoperative hemoglobin levels was 2.15, with an SD of 0.99. A total of three patients received 2 units of leukocyte-poor red blood cells (LPR) as an accepted blood transfusion. There were no reported complications observed during the admission and one month after the operation. This study reported the peri-operative outcomes in the patients with DDH who underwent THA with PSI graft. We found that THA with PSI graft would provide a safe procedure without significant complications. We assumed that the PSI graft in THA may increase the coverage rate of the acetabulum, which may increase the graft union rates. Further cohort studies and randomized controlled trials were needed to confirm our findings.